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Every generation of psychotherapists in the last century includes a group of clinicians dedicated to the psychotherapy of psychosis. The contributors to Outpatient Treatment of Psychosis can claim this ancestry. Although the multi-author chapters in the book all affirm the importance of psychotherapy in the treatment of psychosis, the collection reflects a variety of different perspectives, including the views of Freud, Klein, Bion, Winnicott, Jung, Lacan, and Spotnitz, among others. Readers will find different parts of the book new or familiar, depending on their personal theoretical background. Given the wonderful imprecision of language, because the same psychological idea can be expressed in different words, as I read this engaging book I asked myself, “Is this concept new to me, or is it a rephrasing of something I already know? If it is truly new, do I have sufficient background to understand what the writer is saying?”
David Downing, one of the volume's editors, sets the stage in chapter 1 by tracing the community mental health movement of the 1950s-1970s in the U.S. back to efforts to treat servicemen traumatized in World War II. The policy of “deinstitutionalization” ushered in by neuroleptic medication led to psychotic patients being discharged to the community, but the subsequent decline of liberal politics saw funding for community mental health dry up. Large numbers of chronically psychotic persons have now been reinstitutionalized in prisons and nursing homes. If the treatment of psychosis has withered in the public sector, Downing asks, what can be done on behalf of psychotic persons needing care? His answer: psychotherapists in private practice should rise to the challenge and treat